I.

II.

III.

A.

B.

IV.

V.

VI.

A.

B.

C.

VII.

VIII.

A.

B.

1.

2.

IX.

X.

University System of New Hampshire

Educational Excellence Committee

Thursday, October 24, 2019 9:30 AM (EDT)

Keene New Hampshire

Keene State College

Committee RosterM. Jacqueline Eastwood, Chair; Cathy J. Green, Vice Chair; Amy B. Begg; Jacob A. Bennett; Victoria Bergstrom; Frank

Edelblut; Cailee Griffin; Aura Huot; Shawn N. Jasper; Aaron M. Keaton; Tyler Minnich; Joseph D. Scala; Leo Shattuck;

Wallace R. Stevens; David A. Westover

Call to Order - Chair Eastwood

Consent Agenda

Approval of Minutes, June 27, 2019

Approval of KSC Faculty Promotions

Fall Enrollment - Chancellor Leach - 10 minutes

University System Student Board (USSB) Update - 20 minutes

Nursing In-depth - 60 minutes

Supply and Demand - Chancellor Leach

KSC and RVCC Collaboration - Provost Ockle

UNH $9 Million Nursing Investment Plan - Provost Jones

Top 10 Occupations in NH - Chancellor Leach - 10 minutes

Top Areas of Focus for the Year - Chair Eastwood - 10 minutes

Minimizing Competition among Our Institutions

Leveraging the System Advantage

Online Opportunities

Reaching Nontraditional Students

New Business - 10 minutes

Adjournment

p. 1 of 3

EDUCATIONAL EXCELLENCE COMMITTEE

JUNE 27, 2019

GRANITE STATE COLLEGE CONCORD, NH

MEETING MINUTES Draft for Approval

Committee members present: Frederick Dey, chair; Robert Baines, vice chair; Jacob Bennett; Frank Edelblut; Cathy Green; Hilary Grubbs; Shawn Jasper; Aaron Keaton; Todd Leach; Scott Mason; Christian Merheb; Mackenzie Murphy; Joseph Scala; Wallace Stevens

Nonmember participants: Kassandra Ardinger; Donald Birx; Jamie Burnett; James Dean; Robin Dorff; M. Jacqueline Eastwood; Nancy Fey-Yensan; Wayne Jones; Robin DeRosa; Mark Rubinstein; Leo Shattuck; John Small; Scott Stanley; Melinda Treadwell

Call to Order

Committee Chair Dey called the meeting to order at 8:00 a.m. Approval of Minutes

The following motion was made by Chair Dey, duly seconded, and approved.

VOTED, that the minutes of the April 25, 2019, Educational Excellence Committee meeting be approved as presented in the meeting materials.

Promotion and Tenure Recommendations

Chair Dey called attention to the summary of promotion and tenure statistics provided in the advance meeting materials. The following motion was made by Chair Dey, duly seconded, and approved with no votes dissenting or abstained.

VOTED, on recommendation of the respective presidents, that the Educational Excellence Committee approve the promotion and tenure recommendations for the University of New Hampshire, Keene State College, and Plymouth State University, as presented in the meeting materials.

The individuals approved for the award of tenure and/or promotion in rank are listed below.

University of New Hampshire

Professor

Erin Santini Bell Erik B. Berda Carmen Garcia de la Rasilla Piero G. Garofalo Joel E. Johnson Andrew L. Kun Dain P. LaRoche Ningyu Liu Mihaela Sabin Lucy E. Salyer Judith A. Sharkey

Professor

Anita R. Tucker Christopher M. White Goksel Yalcinkaya Susan Zago

Professor with Tenure

Roger Ford

Associate Professor

Sherine F. Elsawa

Associate Professor with Tenure

Joyce D. Cappiello Elysa L. Hambacher Kyung Jae Jeong Adrienne I. Kovach Kyle S. MacLea Mathew D. MacManes Alecia M. Magnifico Linda Ragland Robert S. Ross Krisztina Varga Harish Vashisth Kang Wu

USNH Educational Excellence Committee, June 27, 2019 p. 2 of 3

Draft for Approval

Promotion and Tenure, continued

Keene State College

Tenure

Philip Barker Angela Barlow Dudley Blossom Kimberly Bohannon Denise Burchsted Jeffrey (Sasha) Davis Emily Robins Sharpe John Sturtz

Professor

Christopher Brehme John Finneran Heather Gilligan Sandra Howard Patricia Pedroza Gonzalez

Associate Professor

William McColloch Irene McGarrity Sarah McGregor Thomas Webler

Plymouth State University

Professor

Jong-Yoon Kim Megan Birch Filiz Ruhm Daniel Lee Christian Bisson Mark Fischler Stephanie Halter

Associate Professor with Tenure

Emma Wright Justin Wright Eric LaFlamme Kathleen Herzig Chantalle Forgues Christin Wixson Linda Carrier

Discussion

Open Education Resources (OER): Provost Stanley, chair of the Academic Technology Steering Committee, introduced Robin DeRosa, director of the PSU Open Learning & Teaching Collaborative, who presented an update on the systemwide Open Education initiative. OER are freely accessible, openly licensed text, media, and other digital resources that can be revised, remixed, and redistributed. USNH faculty use of OER in place of print textbooks and other commercial materials is estimated to have saved students more than $600,000 over two years, from 2015 to 2017. Research shows that use of OER contributes to student retention and success—not only for the two-thirds of students who take a course without the required textbook—it enables expanded learning opportunity by engaging students in the evaluation and building out of open materials, making the student both a consumer and creator of knowledge. With support from the Long-Range Technology Plan, OER stipends are provided to participating faculty to seed conversion and dissemination of resource material to other faculty. USNH, along with CCSNH, are joining with the University System of Maryland, City University of New York, and State University of New York to form the DOERS3 Collaborative (Driving OER Sustainability for Student Success) to support large-scale, system/statewide initiatives committed to advancing innovation in OER. USNH/NH goals include developing “Z-degrees” (zero textbook cost throughout the entire program) and expanding OER to K-12. Academic Quality Metrics: Chair Dey called attention to the annual Academic Quality Metrics report provided in the advance meeting materials. Discussion focused on assessment of student satisfaction and engagement as essential elements for retention and success; improved data analytics and early academic warning systems that support early intervention; on-time graduation; and post-graduation outcomes. Information

Chancellor’s Update: Chancellor Leach presented information about fall enrollment challenges in the context of demographic pressures, regional competition, and USNH market share of NH high school graduates. The Administrative Board held a strategic retreat earlier in the month to develop a systemwide approach to enrollment strategy and revenue enhancement. Further in-depth discussion is slated for the full Board of Trustees meeting. Enterprise Risk Management: Updated systemwide management plans for the two risk areas assigned for oversight to the Education Excellence Committee – Academic Programs and Enrollment – were provided in the advance meeting materials. Discussion occurred within the chancellor’s update (above) and the academic program quality update (below).

USNH Educational Excellence Committee, June 27, 2019 p. 3 of 3

Draft for Approval

University System Student Board (USSB): Student trustees and representatives provided information about recent campus activities related to student governance, commencement ceremonies, and student engagement and retention. Trustee Dey thanked the students for their perspectives and participation over the past year. Academic Plan and Program Review Annual Report; Academic Program Additions/Deletions; Academic Program Quality Assurance: In the interest of time, Chair Dey combined the three academic program items. Provosts’ remarks focused on academic quality in terms of program review, accreditations, professional exam pass rates, and learning assessment outcomes. Adjournment

The meeting adjourned at 10:00 a.m.

UNIVERSITY SYSTEM OF NEW HAMPSHIRE

BOARD OF TRUSTEES

Educational Excellence Committee

Consent Agenda Item

October 24, 2019

Keene State College

To: Educational Excellence Committee

Re: Faculty Promotion Recommendations

Consent Motion

MOVED, on recommendation of President Treadwell, that the Educational

Excellence Committee approve the promotion recommendations for four individuals

at Keene State College, as presented in the supporting material.

Supporting Materials

President Treadwell’s letter of recommendation. The letter is confidential and provided to trustees only. Until formally

approved, the names of the candidates should not be publicly disclosed. (The credentials of the candidates are on file at

the respective institutions.)

Rationale for Proposed Action

During the prior year approval process, the candidates had been denied promotion on procedural grounds and therefore

were not included in the annual recommendations presented to the committee in June. Upon review, the issue has been

resolved and the promotion of each candidate is retroactively supported by KSC.

Approval of the recommended action is sought pursuant to board policy, BOT.II.F:

The Board of Trustees of the University System of New Hampshire awards promotion and tenure on the

recommendation of a President (BOT.II.F.1.).

Institutional promotion and tenure recommendations are presented to the Educational Excellence Committee as

a consent agenda action item (BOT.II.F.3.1.).

Subsequent Review and Approval

Approval by the Educational Excellence Committee is final; no further approval is required.

Submitted by: USNH System Office/hgh

Approved by: President Melinda Treadwell

Fall 2019 Enrollment

Educational Excellence Committee

October 24, 2019

Link to Enrollment Appendix: https://www.gotomyboards.com/Document/RetrieveDocument/556021

2

All New Undergrads

Fall 2019 1-Yr Change

Headcount Percent Number

UNH 3,268 – 9.2% – 331

UNHM 242 – 4.3% – 11

PSU 1,222 – 7.7% – 102

KSC 1,006 – 9.5% – 105

GSC 399 +2.3% +9

Total 6,137 – 8.1% – 540

New Freshmen

Fall 2019 1-Yr Change

Headcount Percent Number

UNH 2,731 – 9.9% – 300

PSU 1,034 – 5.7% – 62

KSC 843 – 11.3% – 107

Total 4,608 – 9.2% – 469

Fall 2019 Enrollment Summary

23.5 k

24.5 k

25.5 k

26.5 k

27.5 k

Fall 10 11 12 13 14 15 16 17 18 19

All New & Continuing FTE

Sca

le =

4,0

00

Includes UNH School of Law 2014 forward.

GSC and PSU preliminary; final FTE is expected to be slightly higher (~ 20 GSC / ~ 40 PSU).

Includes re-admits 2019 and 2018 comparison. GSC preliminary.Note corrections (in blue) to previously posted materials.

3500

4500

5500

6500

7500

Fall 10 11 12 13 14 15 16 17 18 19

New Undergrad Headcount

Sca

le =

4,0

00

Undergrad trend is driven by residential freshmen

Excludes UNH re-admits for comparability over time (policy change effective 2018).

All Students New & Continuing

Fall 2019 1-Yr Change

FTE Percent Number

UNH 14,137 – 3.7% – 542

UNHM 691 – 0.3% – 2

UNHL 313 +21.9% +56

PSU 4,389 – 8.0% – 383

KSC 3,433 – 1.5% – 54

GSC 1,438 – 2.0% – 30

Total 24,402 – 3.8% – 954

3

Fall 2019 Enrollment All Students New & Continuing FTE

0

1000

2000

3000

4000

Fall 10 11 12 13 14 15 16 17 18 19

GSC

Sca

le =

4,0

00

2000

3000

4000

5000

6000

Fall 10 11 12 13 14 15 16 17 18 19

KSC

Sca

le =

4,0

00

2000

3000

4000

5000

6000

Fall 10 11 12 13 14 15 16 17 18 19

PSU

Sca

le =

4,0

00

13000

14000

15000

16000

17000

Fall 10 11 12 13 14 15 16 17 18 19

UNH

Sca

le =

4,0

00

All credit-bearing activity (degree, continuing ed, undergrad, grad). UNH includes Law 2014 forward.

4

Fall 2019 Enrollment FTE

New & Continuing Undergraduate

0

1000

2000

3000

4000

Fall 10 11 12 13 14 15 16 17 18 19

KSC

Sca

le =

4,0

00

RES

NR

0

1000

2000

3000

4000

Fall 10 11 12 13 14 15 16 17 18 19

PSU

Sca

le =

4,0

00

RES

NR

4500

5500

6500

7500

8500

Fall 10 11 12 13 14 15 16 17 18 19

UNH

Sca

le =

4,0

00

RES

NR

All undergraduate credit-bearing activity (degree and continuing ed).

1

Three primary licensed nursing occupations in NH require undergraduate postsecondary education

Licensed Nursing Assistant (LNA)

• Also known as certified nursing assistant/CNA, home health aide

• Program length varies depending on specialized focus, can be as

short as 6-12 weeks

• Board of Nursing (BON)-administered LNA Competency Exam for licensure

• Clinical training typically conducted in nursing homes, skill prep

involves assisting with activities of daily living

~30 providers in NH:

Majority of providers are high schools/voc-tech centers

A few long-term care facilities and LLCs

3 postsecondary institutions – LRCC: general LNA

MCC: Medication Nursing Assistant

WMCC: Patient Care Specialist

Registered Nurse (RN)

• Associate or bachelor’s degree program with extensive clinical

training, all except ‘RN-BSN’ require BON approval

• NCLEX-RN exam for licensure

• Universal employment, bachelor’s offers greater capacity for career

advancement and leadership opportunities

ASN or ADN | Figure 1

Associate of science in nursing, associate degree in nursing

2-year program, intense science and clinical coursework in

what is considered a condensed time frame

9 providers in NH:

CCSNH (all 7), Rivier, St. Joseph School of Nursing

All offer LPN-to-RN completion as well

Data Brief: Undergraduate Nursing Education in New Hampshire FOR USNH INTERNAL USE – IPEDS FY18 DATA ARE PRE-PUBLIC RELEASE

Licensed Practical Nurse (LPN) | Figure 1

• Also known as licensed vocational nurse (LVN)

• 13-month program, extensive clinical, requires BON approval

• NCLEX-PN exam for licensure

• Skill level falls between RN and licensed nursing assistant (LNA)

• Primary employment in long-term care facilities, nursing homes

2 providers in NH:

Harmony Health Care Institute, Merrimack

Salter School of Nursing & Allied Health, Manchester

CCSNH may restore LPN programs pending state support

Direct Entry BSN | Figure 2

4-year bachelor’s of science in nursing, emphasizes liberal arts, advanced

sciences, nursing coursework/clinical, with leadership development and

exposure to public health competencies

6 providers in NH:

UNH, PSU, KSC, Colby Sawyer, Rivier, St. Anselm

Postbaccalaureate BSN

12-18 months, intense coursework/clinical, accelerated BSN for students

who have already completed a bachelor’s degree in any discipline

1 provider in NH:

MA College of Pharmacy Health Sciences (MCPHS), Manchester

(16-mo, $64k)

RN-BSN | Figure 3

• 2-year program for already-licensed RNs

• All NH programs are fully online or hybrid

• Generally no clinical hours required (clinical component qualifies

student to sit for NCLEX, passing NCLEX required for licensure)

6 NH-based providers:

GSC, Colby Sawyer, FPU (hybrid), Rivier, SNHU, St. Anselm (hybrid)

$215

$268

$300 $310 $314 $320

$360

$400

*Hybrid

GSC

-CC

Rate

SN

HU

-CC

Rate

St.

An

selm

*

Co

lby S

aw

yer

GSC

SN

HU

Riv

ier

FP

U*

Online RN-BSN

Tuition Rate perCredit Hour FY19

Figure 3

$14.1k $14.2k

$18.5k

$32.7k

$41.8k$43.6k

NH Resident Rate

Co

lby S

aw

yer

Direct Entry BSN

Annual Tuition & Mandatory Fees FY19

St.

Am

selm

Riv

ier

UN

H

KSC

PSU

Figure 2

$23.0k

$30.0k

$36.4k

ASN ~2 yrs

St.

Jo

sep

h

CC

SN

H

Riv

ier

$23.4k$25.0k

LPN ~13 mo

Harm

on

y

Salt

er

$14.0k

$17.2k

$25.0k

LPN-RN ~1 yr

St.

Jo

sep

h

CC

SN

H

Riv

ier

LPN and ASN

Total Program Cost FY19

Figure 1

2

Data Brief: Undergraduate Nursing Education in New Hampshire

RN: Graduates & Jobs | Figures 5-7

• Due to the numerous limitations in the available data, caution should

be used when interpreting the data in terms of supply and demand.

(See details p3).

• Based on the number of NH RN degree completions reported to the

federal government and the average annual job openings projected

by state government, supply at current levels has fallen short and will

continue to fall short of demand by ~200 nurses per year.

• Planned increases in the annual number of nursing graduates by

~100 over the next biennium by the three USNH residential

institutions will cut the annual gap in half but will not close the gap

entirely.

• Within the 2016-2026 period, factoring the USNH increase in 2021

forward, and factoring the cumulative supply deficit over the 10-year

period, NH will likely experience a shortfall of more than 1,600 RNs.

At current levels, nursing certificate and degree completions are not sufficient to meet workforce demand

704

906

156193

0

200

400

600

800

1000

1200

FY08 09 10 11 12 13 14 15 16 17 18 FY26

NH Nursing Graduates &Workforce Need

RN Grads

Projected Avg AnnualOpenings 2016-2026

LPN Grads

LPN & LNA: Graduates and Jobs | Figure 4

• Of the three types of nurses, licensed practical nurses are

projected to have the lowest number of average annual

openings in the 10-year period. Based on the current level of

LPN preparation, NH could see a shortfall of nearly 400 LPNs

in the workforce by 2026.

• The nursing assistant occupation is projected to have the

highest average annual number of openings among

undergraduate-educated nurses (1,169). Because NH Board of

Nursing licensure does not differentiate between LNAs and

home health aides (and possibly psychiatric aides), the

number of annual openings is likely higher yet (1,388-1,427).

• Due to limitations in reporting requirements for LNA program

completion, the contributing supply side is unknown.

Alternate Analysis

• Supply and demand projections of the nursing

workforce 2014-2030, developed by the U.S.

Department of Health and Human Services,

present NH nursing demand in a different light.

• Projections developed using the HRSA Health

Workforce Simulation Model identify only 7 states

with an RN shortage by 2030. NH RN supply is

projected to exceed demand by 1,100 by 2030.

• NH is projected to be among 33 states with

insufficient supply to meet LPN demand, with a

projected deficit of 2,800 by 2030.

• Scope of analysis does not include LNA.

https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/NC

HWA_HRSA_Nursing_Report.pdf

See p.3 for completions by institution

How does theNH health care

community meet the nursing needs of the state with a

supply shortfall?

NH ranks 10th in the U.S. and 1st in New

England among states with the “most

overworked” nurses.

https://www.medicarehealthplans.com/news/burned-

out-is-your-state-full-of-overworked-doctors-and-

nurses/

FOR USNH INTERNAL USE – IPEDS FY18 DATA ARE PRE-PUBLIC RELEASE

193

906

1169

Projected Average Annual Openings

2016-2026

LicensedPractical

Nurse

RegisteredNurse

LicensedNursing

Assistant

LNA

RN

LPN

NH Employment Security

Figure 4

Figure 5

355

349

158

0

200

400

600

FY08 09 10 11 12 13 14 15 16 17 18

NH RN Graduates by Program

ASN

Direct Entry BSN

RN-BSN

Figure 6

0

200

400

600

FY08 09 10 11 12 13 14 15 16 17 18

CCSNH: ASN Prvts: ASN

USNH: BSN Prvts: BSN

All: RN-BSN

NH RN Graduates by Programby Sector

(excl. SNHU)

Figure 7

(excl. SNHU)

3

47

37

0

250

FY08 09 10 11 12 13 14 15 16 17 18

0 0 15 14 40 86 113 150 152 154 158

Rivier

FPU

N=

RN to BSN Completion

GSC

SNHU (not shown): 220 481 603 774

~74

95

69

40

2518

0

500

FY08 09 10 11 12 13 14 15 16 17 18

246 255 273 256 257 313 340 342 323 311 349

KSC

UNH

Colby

Rivier

PSU

St. A

Registered Nurse

Bachelor's DegreeCompletion

(BSN)

N=

~102

98

58

40

39

38

30201616

0

500

FY08 09 10 11 12 13 14 15 16 17 18

391 384 437 472 462 426 453 405 367 349 355

LRCC

RVCC

WMCCNCC

Rivier

GBCC

St. Jos

MCC

NHTI

Registered Nurse

Associate DegreeCompletion

(ASN)

N=

32

124

0

250

FY08 09 10 11 12 13 14 15 16 17 18

85 73 114 106 137 84 112 104 69 139 156

Harmony

Salter

RVCCSt. Jos

NHTI

N=

Licensed Practical Nurse

Certificate Completion

Data from U.S. Dept. of Education, IPEDS (FY17 and FY18 provisional data, subject to change). For the purpose of identifying nursing supply, Rivier numbers reflect an estimated allocation of its total BSN completions across its direct entry and RN-BSN programs. No adjustment is made to Colby Sawyer and St. Anselm BSN numbers, which may include a small number of RN-BSN completions. SNHU is excluded from the RN-BSN count because of the inability to identify NH-based completers.

Data Brief: Undergraduate Nursing Education in New Hampshire

Notes for interpreting the data

Bureau of Labor Statistics adopted a new method for the 2016-2026

occupational projections that captures, in addition to workforce

entrants and exits, an aspect of occupational movement within the

workforce. This factor adds to the total number of openings the

number of those leaving an occupational category for another job but

are not leaving the workforce itself. The method does not, however,

account for the number of those filling occupational openings from

within the existing workforce. The effect represents turnover but is not

of itself an indication of demand for new workers.

The reported completions data do not necessarily translate to NH

workforce on an individual basis. U.S. Dept. of Education (IPEDS) collects

completions data by program but does not differentiate between

online and on-site completers, location of online learners, or student

residency. Further, BSN completions are not differentiated by direct

entry (new RN) or RN-BSN (upskilled RN). This obscures the assessment

of nursing entrants into the workforce, as opposed to RNs already in the

workforce seeking a higher credential for professional advancement.

Other than professional exam pass rates, the NH Board of Nursing does

not disclose nursing program data. BON directs requests for data (such

as number of exam takers) to the program provider, many of which are

private institutions, not subject to NH Right to Know law.

MCPHS data are excluded from this brief. MCPHS is based in MA with a

satellite campus in Manchester, NH, offering an on-site postbaccalaureate

BSN program. (MCPHS also offers on online RN-BSN.) IPEDS data are

reported for MCPHS as a whole and provides no indication of the program

completion at the NH location.

According to their web sites, three NH community colleges currently offer

an LNA program, however, no program completions have been reported

to date in the federal IPEDS data.

Federal postsecondary data cannot be used to gauge LNA workforce

supply. Postsecondary data omit a significant portion of LNA program

completions, as the majority of program providers (high schools, tech

centers) are not eligible for Title IV aid, and, as such, are not subject to

federal reporting requirements.

New RN production in total (ASN & BSN combined) has remained relatively flat since 2010 FOR USNH INTERNAL USE – IPEDS FY18 DATA ARE PRE-PUBLIC RELEASE

The FEAST and FAMINE of Health--Care Staffing

BY MELANIE PLENDA

Reproduced with permission from Business NH Magazine for limited use specific to USNH Board of Trustees meetings 10/2019

T he warning drums have been beating for years about work­force shortages in health care and, while shortages persist, experts project some seg­

ments of health care could actually see a surplus of employees in the next decade. Yet that feast is expected to be accompanied by other health-care segments continuing to experience famine.

Health care is a major economic driver in NH, fueled by the state's older popula-

tion. When asked which sectors of health care are most affected by workforce short­ages in the state, the most common refrain from those in the trenches is, "where aren't we seeing shortages?"

Not enough nurses, not enough doctors and few techs and assistants are common challenges. Some hospitals even struggle to attract maintenance workers to fill the needs of their 2417 operations.

"We are seeing shortages across the board," says Sarah Cwrnjer, Dartmouth

> 2019 Health Care Guide <

Hitchcock Health System's vice president of workforce strategy. "Ten years ago we would post a job and there would be a hun­dred applicants and today we post a job and for a very similar position, we'll see some­thing along the lines of 11."

Yet NH's health-care industry may end up in better shape than other states in the coming years. RegisteredNurses.org ana­lyzed future registeFed nursing employ­ment estimates by the National Center for Health Workforce Analysis and found sev-

-Reproduced with permission from Business NH Magazine for limited use specific to USNH Board of Trustees meetings 10/2019

eral states will face significant shortages of registered nurses by 2030 but not NH.

California is expected to be short the most registered nurses ( 45,500), while Alaska is projected to have the most job vacancies (22. 7% ). Texas, New Jersey, South Carolina, Georgia and South Da­kota are expected to experience shortages as well, according to the site's analysis. While NH cracked the top 10 for having the greatest difference between supply and demand for registered nurses, it is actually expected to have a slight surplus of 1, 100 by 2030.

The Nursing Shortage The promise of greener pas­

tures is still a decade away. The current state of health-care em­ployment is far bleaker. As of April, the number of full-time­equivalent employees budgeted in NH for nursing, behavioral health, rehabilitation, technical and senior leadership positions at 20 hospitals across the state was 21,427, according to a sur­vey conducted by the NH Hos­pital Association. However, only 19,392 positions were . staffed, leaving 2,035 vacancies or a total vacancy rate of 9 .5%.

The need for nurses is highest nationwide and in NH, according to the survey. Vacancies for nurs­es in intensive care, operating rooms and anesthesia hover at around 15%.

''Nursing would be our big­gest [challenge] because it's our biggest group of employees," says Merryll Rosenfeld, vice president of human resources for Catholic Medical Center (CMC) in Manchester. And it's not a pipeline issue.

Jennifer Cassin, vice president of nurs­ing for CMC, says there's no shortage of new nursing graduates or students. CMC saw 600 students come through the hos­pital last year, as part of their training and hired 4 7. The challenge lies in the number of retirees leaving and a high turnover rate, particularly among new nurses.

"You tend to lose more in that first year or within the first couple of years follow­ing," Cassin says, a trend that is particular­ly pronounced among millennials. "Once they get their experience, or their orienta­tion as we call it, they're looking to do re-

5 2 S E P T E M B E R 2 0 1 9 BuslnessNHmagazlne.com

location. They like to be travelers. They're not afraid to move on in their careers and career advancement."

Cassin says the shortages create sched­uling challenges, exacerbating the long and non-traditional hours nurses work. And with higher pay available in nearby Boston, retention becomes an issue.

"A lot of them are going down to Bos­ton because they could work three days a week and make oodles of money and then they come back home to New Hampshire," Rosenfeld says. (See sidebar below.)

While Boston offers higher pay in gen­eral, "New Hampshire actually pays a little more," than other N orthem New England states, says Jason Hooper, nursing manager for MAS Medical Staffing, which special­izes in traveling nurse programs and staffing health-care facilities.

More employers also are offering sign­ing bonuses in certain nursing specialties, and, Hooper says, taking advantage of available federal stipends that can offset living costs for traveling nurses.

Mental Health Sector Challenges Another health-care sector experienc­

ing gaps is behavioral health. According to a NH Hospital Association survey, there is a 13.3% vacancy rate among behavioral

health nurses and a 13.5% vacancy rate for behavioral health clinicians.

While the survey didn't specify this, the state has a shortage of practicing psychia­trists. While the number of active licenses for psychologists in the state increased from 559 in FY 2017 to 639 in FY 2018, according to NH Employment Security, there were only 60 psychiatrists in NH in 201 7. (Psychiatrists are medical doctors who can prescribe medication.) By com­parison, there were 910 family and general practitioners employed in NH.

"There's a national shortage of psychiatrists," says William Torrey, professor and vice chair for clinical services for the de­partment of psychiatry at Dart­mouth's Geisel School of Medi­cine and Dartmouth-Hitchcock. "Studies show that most coun­ties in the country don't have enough psychiatrists."

There are many reasons, Tor­rey says. First, more than 60% of psychiatrists are 60 or older. This means many of them are retiring or cutting back hours, reducing overall capacity in the mental health system. Further, he says, there's a growing recognition of the need for psychiatrists in nurs­ing homes, jails and other non­traditional settings.

Adding to the demand for services are such advancements as telemedicine that provide pa­tients in rural areas with greater access to services. "I've taken care of people in a nursing home in Rutland from my office here at

DHMC," Torrey says, explaining that while it makes it easier for patients to access his services, it also creates more competition for his time. "There's just a lot more de­mand for the service," he notes.

Psychiatrists historically have been underpaid by insurance, adding to the short­age woes. "Right now, if we hire a psychia­trist here and keep them really busy doing outpatient work, they cost almost twice as much as they bring in," Torrey says. "That means that a substantial percentage of the psychiatrists- I think about 40 percent of psychiatrists--do not take insurance because insurance companies make it really difficult to get paid and they're not paying enough." That, in turn, cuts down on how many psy­chiatrists are available to work at community

Reproduced with permission from Business NH Magazine for limited use specific to USNH Board of Trustees meetings 10/2019

> 2019 Health Care Guide < ~

Nursing students at River Valley Community College

mental health centers, hospitals and other facilities that have to take insurance, he says.

Even putting reimbursement rates aside, psychiatrists, nationally and in NH, simply get paid less than other practitioners, mak­ing it hard to recruit new students into the field. According to NH Employment Secu­rity, psychiatrists make an average of $108 per hour. Experience raises that figure to $128 per hour, while entry level psychia­trists make roughly $71 per hour.

By comparison, general practitioners make an average of $127 per hour, inter­nists, $133 and surgeons, $148.

That is starting to change and psychia­trists are starting to command better sala­ries, Torrey says, which should help attract more medical students into psychiatry. Also helping to attract students is increased re­search in brain science as well as a dimin­ishing stigma around mental health.

But sometimes that's not enough. "The state has lost a lot of inpatient hospital ca­pacity over the years with hospitals closing down inpatient units," Torrey says. "You need to have jobs for people to stay in state."

Technician Shortages Soar Another area experiencing shortages

is pharmacy technicians with vacancy

rates at 16.6%- the most vacancies of all the positions surveyed by the NH Hospital Administration.

Nurses and medical techs need to be li­censed or credentialed and the cost of their education can be out of reach for some who may decide to pursue other career paths,

·Dartmouth-Hitchcock's Currier says. For example, someone looking to be a

licensed nursing assistant has to pay for classes that cost at least $1,300 to $1,500. Then he or she has to take and pay for an exam and wait for the results. Then they have to pay for the licensing itself and wait through that process to find out if they will be licensed. Then after that, they wait through a background check, they are hired and can get to work- for roughly $15 per hour.

"I can go into Kohl's [department store] and there's a little sign that says 'text this number if you 're interested in an interview' and I can text that number in this dressing room and they will offer me an interview and a job before I leave the store," Currier says. "In short, for all the time, effort and expense of getting one of these lower-skilled tech jobs the person thinks, 'I could've taken a job elsewhere for $15."'

What's Behind the Current Shortages Currier and others point to a number

of factors leading to the shortages facing NH's health-care industry: aging popula­tion, growing competition for a dwindling number of available qualified workers, and ease of mobility that allows new graduates to get out of Dodge and take a job elsewhere.

And there are systemic factors at play here too, says Currier, including low Medicaid reimbursement rates that result in lower pay for behavioral and mental health practitioners as compared to other provid­ers; strict regulations; and not enough af­fordable housing, public transportation and high-speed internet to attract and retain young professionals lured by the bright lights, bigger paychecks and better ameni­ties in Boston and other cities. "It's kind of a perfect storm," says Currier.

Gains and Surpluses Ahead Demand for health-care workers will

continue. By 2026, the health-care and so­cial assistance sectors are expected to see the highest job gains, with an increase of 14,189 jobs, and contribute roughly one­third of new jobs in the state, according to the most recent NH Employment Projec­tions by Industry and Occupation report,

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conducted by NH Employment Security. This is an expected 15. 7% growth. The next fastest-growing sector- professional, sci­entific and technical services- will see an employment gain of 13. 7%.

And while workforce shortages will per­sist in some areas of health care, others are expected to see a surplus. By 2030, it's pro­jected there will be a 5.4% surplus of reg­istered nurses but a 3 7% shortfall of LPNs in NH, according to a 2017 report issued by the U.S. Department of Health and Human Services, Health Resources and Services Administration conducted by the National Center for Health Workforce Analysis.

There also will be a projected surplus of primary care practitioners across the board by 2025, according to another DHHS re­port analyzing projections for that sector. The report projects NH will have a 4.5% surplus of primary care phy­sicians; a 62.5% surplus of primary care physicians as­sistants; and a 160.7% sur­plus of primary care nurse practitioners.

getting jobs as RNs and then a lot of them complete their bachelor's degrees while they're working."

Competition to get into these nursing programs is high as spaces are limited. "The programs are highly selective and in high demand and it's hard to grow," Wil­liams says. "You can't.really grow the pro­grams. We could double the amount of stu­dents in our nursing program; the problem is that you need clinical sites. There's only so many clinical sites in the state. And also you need the faculty, because we're train­ing people to deal with people's lives and so there's criteria that needs to be met." A simple .Google search for nursing faculty jobs in NH produced a list of more 70 open positions, many of which require a master's or bachelor's in addition to expe­rience and licensure.

nursing program educators, says this is an is­sue with which its board regularly grapples.

"We want to make sure there's a balance of meeting the needs and having safe pa­tient care," says O'Neill, who also serves as vice president of human resources for Portsmouth Regional Hospital. "We want to make sure that professors teaching either LNA courses or nursing courses have the appropriate experience."

With limited slots for nursing courses and a perennial need for more faculty, Wil­liams says River Valley offers students an alternative route into health care. "Our bread and butter is the allied health fields," he says. "Because the nursing class fills up and has limited spots, we try to find other interests and other pathways," for students.

One of those pathways involves start-ing as an LNA and then continuing to take

classes and training to become an LPN and then a registered nurse. The college also of­fers certificate programs to become medical adminis­trative assistants or medical assistants. It also offers an associate degree for medi-

~ cal laboratory technicians, a 0

~ program expanding by one ~ new faculty member this year. ~

~ "We've been running a class ~ of 12 students every year but ~ the demand is for 18 to 22 ! students because the jobs are ~ there," Williams says.

While a potential surplus of nurses and doctors will likely carry its own chal­lenges; for the time being, the health-care industry must contend with current short­ages. Providers across the state aren't throwing up their hands in surrender, though. Officials in the state are de­veloping ways to combat the trend and collaborating to meet community needs.

Students gain hands-on experience at White Mountain Community College's certified clinical medical assistant

apprenticeship program.

~ Other programs growing u in popularity include occu-

pational, physical and re­spiratory therapy. "Students

The Pipeline Colleges specializing in health-care pro­

gramming are encouraging students and potential students to look to nursing and other high-demand fields in health care. Alfred Williams, president of River Valley Community College, says one in 10 gradu­ates from the community college system is in a nursing field.

"The demand is so high," he notes, add­ing that some are shocked to find out that 10% of graduates of the community col­lege system are going into nursing careers. "There's no other major that even comes close to that."

Furthermore, 97% of the community college nursing grads end up with a job in NH, he says. "It's a great program for students because in two years, they end up

5 4 S E P T E M B E R 2 0 1 9 BuslnessNHmagazlne.com

Finding LNA faculty is equally tough, but Currier of Dartmouth says some regula­tory tweaks could make a difference. "We can't get out of our own way. The current law around who can teach a licensed nursing­assistant-training program requires that the instructor have long-term care in their back­ground," she says, explaining even if she had a nurse with 25 years of experience work­ing in an acute care hospital and with an ag­ing patient population, he or she wouldn't be eligible to teach. "It's almost impossible to get that person approved as an instruc­tor" because he or she had never worked in a long-term care facility. "Finding ways to solve some of that would be great."

Samantha O'Neill, vice chair of the NH Board of Nursing, responsible for approving

who graduate in respiratory therapy are making over $50,000 coming out of the program," Williams says. "It's not just nursing that can lead to these really high salaries."

Colleges are offering more career path­ways by partnering with local hospitals on creating apprenticeship programs. White Mountain Community College recently de­veloped a medical assistant apprenticeship program with several area hospitals. The idea is to quickly produce an initial cohort of medical assistants to meet hiring needs. In some cases, hospitals had positions that went unfilled for 18 months, according to White Mountain Community College offi­cials. Based on an "earn-while-you-learn" model, students get paid to go to school and instead of going through a two-year cer-

Reproduced with permission from Business NH Magazine for limited use specific to USNH Board of Trustees meetings 10/2019

> 2019 Health Care Guide < ..,.

1- ------

Nurses participate in the StaRN program, a nurse residency program specifically designed for new graduate nurses. The program is offered through Portsmouth Regional Hospital.

tificate program, they earn their certificates within 12 to 15 weeks.

"Yes, it's intense," says Chuck Lloyd, president of White Mountain Community College, "but it's done after that period. You've got your hours in and you're back on the job. So shifting careers for some of these folks happens a lot quicker."

Tamara Ann Roberge, coordinator for workforce development at White Mountain Community College, says the apprentice­ship program plays a key role in attracting people who might otherwise be shut out by the expense or time needed to get licensed.

"For a lot of people in North Country, college is not in their horizon," Roberge says. The apprenticeship program "has helped open up some avenues for people who might not have considered college .... Finding different ways of educating people while attaining those skills needed by the employers is a big deal."

Roberge says the college is developing training programs specific to individual hos­pitals so that new recruits and current employ­ees can upgrade their skills and earn while they learn.

Dartmouth Hitchcock is building part­nerships with local colleges, including

Colby Sawyer and River Valley to enhance their apprenticeship program. "We 're trying to build a combination, work and education super highway with lots of exit and on ramps that allow people to come in, dial up and dial back their career in a way that fits them and keeps them working," Currier says.

Roberge says more grants to help offset the cost of training would allow the appren­ticeship model to thrive.

It is also essential to engage students at a younger age and make them aware of careers in health care, says Lloyd. White Mountain Community College is using funds from the GEAR UP grant to educate middle school students about health-care careers. (GEAR UP is a federal grant pro­gram designed to increase the number of low-income students prepared to enter and succeed in post-secondary education.)

"By the time yoµ get to high school, you're starting to work with your school counselors to really choose a path and take the correct courses that are going to align with the prerequisites for those programs," Lloyd says, adding that students really begin to think about what they want to be, when they are in the sixth or seventh grade. "It's important to get on a pathway at that point."

Legislative Fixes The challenges of recruiting health­

care professionals in NH go well beyond paycheck and education. Lack of afford­able housing, little or no available public transportation and limited broadband are all barriers to recruiting and retaining workers. "This is really a multisystem failure in some ways," Currier says, explaining she can present a compelling case for taking a job in NH until people look at housing prices.

According to the most recent NH Hous­ing Finance Authority survey, the average monthly rent for a two-bedroom unit with utilities is $1,296. This has increased 19% in the last five years and it is the fifth consecu­tive year that rents have increased statewide.

The survey found that NH's vacancy rate for two-bedroom units stands at 1.96%. In comparison, the U.S. vacancy rate is 7% and 5.1 % in the Northeast. Further, a vacancy rate of 4% to 5% is considered a balanced market for supply and demand. Vacancies are particularly low in the southern counties of Hillsborough, Merrimack, Rockingham and Strafford, as well as in the communi­ties of Hanover and Lebanon in the Upper Valley. The majority of large hospitals in the state are located near these areas.

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Currier says while there are individu­als, organizations, agencies and busi­nesses working on the housing issue, they are doing so in silos. "We are a small state that feels like we have to solve everything locally. A lot of organizations out there are working on pieces of this problem, but . . . less gets done because we 're all trying to farm it individually with small dollars. I would love to see us find a way to come together with a solution around some housing."

Meanwhile, hospitals are looking at ways to retain the existing workforce. Rosenfeld and Cassin at CMC are examin­ing ways to promote employees, and also stave off compassion fatigue and burnout, which can lead to higher turnover.

To that end, CMC offers pastoral care to staff and allows nurses some level of self­scheduling to mitigate stress. "It's finding that level of what is work-life balance," Cassin says. CMC also helps staff debrief after a stressful day by speaking with a group about difficult, complex patient situ­ations and getting feedback and support.

Further, hospitals are looking for ways for these initial incentives to turn into long-

5 6 S E P T E M B E R 2 0 1 9 BuslnessNHmagazlne.com

Students in the nursing simulation lab at UNH

term benefits for both the employee and the organization. For example, several hos­pitals now offer tuition assistance to earn advanced certificates and degrees as well as creating pathways for advancement within the organization.

Portsmouth Regional Hospitals of­fer tuition reimbursement and loan as­sistance programs to LNAs and promotes form within when possible, O'Neill says. "We 're trying to keep nurses challenged and advance their career if they so desire," she notes.

Looking to the Future Increasingly, health-care centers are

building partnerships to address workforce issues. Earlier this year, hospitals and clin­ics across the state formed a behavioral health collaborative to discuss the chal­lenges they are facing and to develop a set of best practices.

Also this year, the University of NH became a Project ECHO hub and launched Partnership for Academic Clinical Tele­practice (PACT).

Marcy Doyle, clinical and quality im­provement director for the Institute for

Health Policy and Practice NH Citizens Health Initiative, and an adjunct professor of nursing at UNH, says the goal is to bring together interdisciplinary specialists and community-based practitioners using web conferencing technology along with UNH's nurse practitioner students. Doyle explains that during these sessions, a de-identified patient case in NH is presented and dis­cussed, offering everyone a chance to learn from and teach each other.

For this first project, the team is focused on medications for addiction treatment. Doyle says this will help nurse practitio­ner students receive the hours and training needed to qualify for the federal waiver al­lowing them to prescribe such medications to those who need it. Additionally, it will of­fer training, support and guidance to those in practice who have their waiver, but may be hesitant taking on substance abuse pa­tients for fear they lack the training.

Currier says she's hopeful that as time goes on, there will be even more talk about ways people across disciplines and sec­tors can come together to find solutions. "I would love to see us get to the next page, and get some solutions in place." •

Reproduced with permission from Business NH Magazine for limited use specific to USNH Board of Trustees meetings 10/2019

Educational Excellence CommitteeOctober 24, 2019

Dr. Ockle Johnson, Interim Provost

Nursing

Keene State College credential conferred• Baccalaureate in nursing• RN to BSN completion (not active at this moment)• Full national accreditation until 2028 and full recognition by State of

NH Board of Nursing

Why a partnership with Community College System of New Hampshire?• Credential web---LNA, LPN, ARN, RN, BSN• Reduced cost and more efficient credentialing

Our priority:Serving our region and building robust partnership with educational partners, hospitals and professional credentialing organizations

River Valley Community College at

Keene State College

• RVCC co-located and smoothly sharing laboratory and classroom spaces

• Nursing program directors working well together to plan the future

• Exploring collaboration to deliver a web of nursing/allied healthcare credentials

• Considering “wrapped RN to BSN”• Curricular mapping shows promise and challenges

Challenges and Priorities

Accreditation• Keene State College – Commission on Collegiate Nursing

Education (CCNE)• River Valley Community College – Accreditation

Commission for Education in Nursing (ACEN)

Faculty sharing and program deliveryBusiness modelsCohort and curriculum management

Net New Annual*

Physical Therapist 377 111

Physician, Surgeon 204 72

Lawyer 143 98

Health Specialties Teacher - Postsecondary 113 59

Family & General Practitioner 96 33

Veterinarian 96 27

Dentist - General 91 26

Business Teacher - Postsecondary 69 45

Psychologist - Clinical, Counseling, School 58 39

Pharmacist 52 53

Net Change Annual*

Physical Therapist 377 111

Lawyer 143 98

Physician, Surgeon 204 72

Health Specialties Teacher - Postsecondary 113 59

Pharmacist 52 53

Business Teacher - Postsecondary 69 45

Psychologist - Clinical, Counseling, School 58 39

Medical Scientist, excl. Epidemiologist 36 36

Family & General Practitioner 96 33

Postsecondary Teacher - nonspecified 19 33

Net Change Annual*

Counselor - Mental Health 225 138

Counselor - School, Guidance, Vocational 65 128

Education Administrator - Elementary & Secondary 34 110

Librarian 33 97

Nurse Practitioner 351 92

Occupational Therapist 231 86

Health Care Social Worker 101 79

Instructional Coordinator 68 70

Education Administrator - Postsecondary 43 66

Physician Assistant 218 59

Net New Annual*

Nurse Practitioner 351 92

Occupational Therapist 231 86

Mental Health Counselor 225 138

Physician Assistant 218 59

Health Care Social Worker 101 79

Speech-Language Pathologist 71 39

Instructional Coordinator 68 70

Counselor - School, Guidance, Vocational 65 128

Rehabilitation Counselor 51 58

Statistician 45 15

Net Change Annual*

Registered Nurse 1853 906

Preschool Teacher, excl. Special Ed 265 333

Paralegal, Legal Assistant 157 137

Dental Hygienist 185 97

Veterinary Technician 199 96

Electrical & Electronics Engineering Technician 2 93

Physical Therapist Assistant 143 91

Web Developer 105 62

Human Resources Assistant, excl. Payroll & Timekeeping -12 51

Architectural & Civil Drafter 37 50

Net New Annual*

Registered Nurse 1853 906

Preschool Teacher, excl. Special Ed 265 333

Veterinary Technician 199 96

Dental Hygienist 185 97

Paralegal, Legal Assistant 157 137

Physical Therapist Assistant 143 91

Web Developer 105 62

Respiratory Therapist 92 30

Radiologic Technologist 61 46

Diagnostic Medical Sonographer 40 16

Net New Annual*

Personal Care Aide 2589 1525

Food Prep/Server, incl. Fast Food 1965 2733

Registered Nurse 1853 906

Software Developer - Applications 1454 507

Waiter/Waitress 1089 2560

Nursing Assistant 964 1169

General & Operations Manager 949 1045

Retail Salesperson 931 3893

Stock Clerk, Order Filler 804 1851

Cooks - Restaurant 782 922

New Hampshire Occupational Projections 2016 to 202610-Year Net Change and Average Annual Openings

TOP 10: NET NEW JOBS BY 2026

*Average annual openings reflect new jobs plus vacancies from workforce exits and transfers to other occupations. | Education level is the minimum required.Data from New Hampshire Employment Security, Economic and Labor Market Information Bureau.

TOP 10: AVERAGE ANNUAL OPENINGS*

Net Change Annual*

Cashier -507 4106

Retail Salesperson 931 3893

Food Prep/Server, incl. Fast Food 1965 2733

Waiter/Waitress 1089 2560

Stock Clerk, Order Filler 804 1851

Office Clerk - General -142 1836

Personal Care Aide 2589 1525

Janitor, Cleaner, excl. House Cleaner 694 1443

Customer Service Rep 276 1229

Nursing Assistant (LNA) 964 1169

All

Ed

uca

tio

n L

evels

Net New Annual*

Software Developer - Applications 1454 507

General & Operations Manager 949 1045

Financial Manager 712 379

Accountant, Auditor 506 526

Market Research Analyst, Marketing Specialist 467 259

Manager - nonspecified 353 366

Management Analyst 347 239

Business Operations Specialist - nonspecified 303 374

Medical & Health Services Manager 290 158

Sales Rep - Wholesale, Mfg, Tech/Scientific 262 378

Ass

ocia

te R

eq

uir

ed

Ba

ch

elo

r's

Req

uir

ed

Net Change Annual*

General & Operations Manager 949 1045

Accountant, Auditor 506 526

Software Developer - Applications 1454 507

Elementary Teacher, excl. Special Ed 115 413

Financial Manager 712 379

Sales Rep - Wholesale, Mfg, Tech/Scientific 262 378

Business Operations Specialist - nonspecified 303 374

Manager - nonspecified 353 366

Secondary Teacher, excl. Special Ed, Career-Tech 106 350

Market Research Analyst, Marketing Specialist 467 259

Ma

ster’

s R

eq

uir

ed

Do

cto

rate

Req

uir

ed

Health Sciences Initiative

Health Sciences InitiativeUNH’s Commitment to Building

NH Healthcare WorkforceThe operating budget adopted by the legislature in September included $9 million for the UNH nursing program to grow Nursing and Health Professions.

The Law States:

Appropriation; University of New Hampshire Nursing Program. There is hereby appropriated to the University System of New Hampshire the sum of $9,000,000 for the fiscal year ending June 30, 2020 for the University of New Hampshire will:

• add nurse practitioner programs with additional specializations in acute care and psychiatric mental health; increasing the number of annual graduates in the bachelor of nursing program

• adding an occupational therapy assistant and occupational therapy doctorate programs

• increasing the number of annual graduates in the speech and language pathology program

UNH committed $3.3M toward the project.

Meeting the Legislation

The initiative includes both capital and academic/programmatic components and will be accomplished in phases.

• Develop and expand academic programs to meet the legislation

• Additional classrooms and office space are necessary to support the growth of the programs

• Construct a state-of-the-art, certified patient simulation center

• Bring fully online a TelePractice Center to expand program and service reach and access across NH

• Develop interprofessional instructional spaces to teach team-based health care

• Hire faculty and clinical staff to support the programs

Program Timeline

USNH 2015-2019 Nursing Enrollments

NH Public Higher EducationHealth Care Summit

• Understanding the health care workforce needs in the state of NH and how public higher education can address them

➢ Hosted at UNH with the support of the Health Sciences Initiative

➢ Including partners from our sister institutions in USNH and CCSNH

➢ Including partners and leaders from the NH Healthcare Industry

• Early 2020